NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics
2.2.0 - ci-build
NHS North West Genomics - Local Development build (v2.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2026-09-20 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="ChimerismTestAdditionalAskAtOrderQuestions"/>
<meta>
<profile
value="https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"/>
</meta>
<language value="en"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire ChimerismTestAdditionalAskAtOrderQuestions</b></p><a name="ChimerismTestAdditionalAskAtOrderQuestions"> </a><a name="hcChimerismTestAdditionalAskAtOrderQuestions"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-NWQuestionnaire.html">Questionnaire</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">**Test Specific Additional Ask At Order Entry Questions** used alongside the
[common core order form](Questionnaire-GenomicTestOrder.html) for the
"Chimerism Testing Blood (PB)" order screen within Histocompatibility and
Immunogenetics orders (SNOMED CT `909871000000100`) - the same "Test
Specific" tier pattern [WGS Test Additional Ask At Order Entry
Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) follows
for WGS orders - see
[Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and
[Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions).
For the sibling HLA testing order screen, see
[HLA Tests - Transplant Ask At Order Entry](Questionnaire-HLATestsTransplantAskAtOrderEntry.html).
Extracted from the `NTE` segments of a live Histotrac `ORM^O01` order for a Chimerism
Testing (Performable) test - see the worked
[example](HistocompatibilityAndImmunogenetics.html#chimerism-testing-ask-at-order-entry)
for the full message. Unlike HLA Tests - Transplant, this order carries only two `NTE`
segments, and in the reverse order (Specimen Source before Patient Test(s)). See also
[Chimerism Testing Result Panel](Questionnaire-ChimerismResultPanel.html) for the
(separate) structured *result* payload this order eventually produces.
**Research summary**: as with [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html),
no NHS England or NHSBT-published order-comms/interoperability standard was found
specifically for Chimerism testing order entry. NHSBT's INF136 "User Guide for
Histocompatibility and Immunogenetics Diagnostics Services" defines `FRM1010` "H&I
Haematopoietic Stem Cell Transplantation (Recipients & Donors)" as the relevant national
request form for post-transplant chimerism monitoring, but does not publish a
FHIR/LOINC/SNOMED binding for the specific test-panel or specimen-source values Hive
uses. See each item below for candidate LOINC/SNOMED codes.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://fhir.nwgenomics.nhs.uk/Questionnaire/ChimerismTestAdditionalAskAtOrderQuestions#2.2.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.AskAtOrderEntry" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> AskAtOrderEntry</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ask At Order Entry Questions</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" id="item.ChimIG/specimen_source" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> ChimIG/specimen_source</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Specimen Source</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Definition: <a href="http://hl7.org/fhir/R4/specimen.html#Specimen.type.coding.code">Specimen.type.coding.code</a><br/>Options: <a href="#opt-item.ChimIG/specimen_source">2 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item.ChimIG/specimen_source-designNote" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> ChimIG/specimen_source-designNote</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Confirmed as this 2-value list (Blood (PB), Bone Marrow (BM)) from the
Hive/Histotrac order-entry UI's Chimerism panel - a different list from the
Blood/Buccal/Other list [HLA Tests -
Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) uses for the
same underlying `code` (LOINC `66746-9`), since the two order screens offer
different specimen-source options in Hive. Coded locally against the
`NWGMSA` CodeSystem rather than the EU/UK/NW-compatible
[Specimen Type](ValueSet-specimen-type.html) value set, to match what Hive
actually offers for this exchange. Deliberately given its own
`ChimIG/specimen_source` linkId rather than reusing the base [Genomic Test
Order](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type
item - the IG Publisher's Questionnaire derivation validator does not support a
`derivedFrom`/`extends` item reusing a base item's linkId while also declaring
more than one `answerOption`. Ordered first (before Patient Test(s)) to match
`NTE|1` in the live Histotrac order - the reverse of HLA Tests - Transplant, where
Patient Test(s) comes first.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" id="item.ChimIG/specimen_source-reference" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> ChimIG/specimen_source-reference</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Post-transplant chimerism monitoring conventionally uses peripheral blood, with
bone marrow used for deeper/marrow-level engraftment assessment - consistent with
this 2-value list. If a coded alternative to the local `NWGMSA` codes is wanted,
the [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate
binding (e.g. whole blood specimen for Blood (PB); bone marrow specimen for Bone
Marrow (BM)). No dedicated NHS-published specimen-type binding specific to H&I
chimerism testing was found.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" id="item.ChimIG/patient_test" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> ChimIG/patient_test</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Patient Test(s)</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Definition: <a href="http://hl7.org/fhir/R4/servicerequest.html#ServiceRequest.orderDetail">ServiceRequest.orderDetail</a><br/>Options: <a href="#opt-item.ChimIG/patient_test">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item.ChimIG/patient_test-designNote" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> ChimIG/patient_test-designNote</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Which chimerism panel/lineage is being tested - the same Ask At Order Entry
pattern as `HistoIG/patient_test` on
[HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html)
(`repeats = true`, since the Hive UI presents them as checkboxes - more than one
may be selected per order). Confirmed as this fixed 5-value checklist from the
Hive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem, as
no NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. Ordered second
(after Specimen Source) to match `NTE|2` in the live Histotrac order, whose
NTE-3 value carries a `(PB)` suffix ("Chimerism Peripheral Blood (PB)") the Hive
checkbox label itself doesn't show - the same OBR-4-restatement behaviour as HLA
Tests - Transplant's Patient Test(s) item. Mapped to `ServiceRequest.orderDetail`
rather than `ServiceRequest.code` - the same reasoning as that item:
`ServiceRequest.code` is single-cardinality and already targeted by the base
[Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item,
with no `enableWhen` to say which wins, while `orderDetail` is repeating and
intended for exactly this kind of further order qualifier.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" id="item.ChimIG/patient_test-reference" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> ChimIG/patient_test-reference</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">No MFT/NHS England code set was found for these five specific test names. LOINC
has short tandem repeat (STR)/chimerism-adjacent panels (e.g. `48018-6` Gene
studied, engraftment-monitoring local codes used elsewhere in genetics
laboratories) but no exact match for a CD3/CD15/CD19 lineage-specific chimerism
checklist was confirmed - a candidate future binding if a coded alternative to
the local `NWGMSA` codes is wanted. See also this IG's existing
[Chimerism](CodeSystem-Chimerism.html) CodeSystem, which covers the *result*
payload's OBX-3 sub-identifiers (STR/IM/RANGE/CV/EXT/PURE/POST/DTP/DID) rather
than these order-entry test-selection values.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.ChimIG/specimen_source"> </a><p><b>Answer options for ChimIG/specimen_source </b></p><ul><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismBloodPB ("Blood (PB)")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismBoneMarrowBM ("Bone Marrow (BM)")</li></ul><a name="opt-item.ChimIG/patient_test"> </a><p><b>Answer options for ChimIG/patient_test </b></p><ul><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismPeripheralBlood ("Chimerism Peripheral Blood")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD3 ("Chimerism CD3")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD15 ("Chimerism CD15")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismCD19 ("Chimerism CD19")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismLineageOther ("Chimerism Lineage Other")</li></ul></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
<valueCoding>
<system value="http://hl7.org/fhir/version-algorithm"/>
<code value="semver"/>
</valueCoding>
</extension>
<url
value="https://fhir.nwgenomics.nhs.uk/Questionnaire/ChimerismTestAdditionalAskAtOrderQuestions"/>
<version value="2.2.0"/>
<title value="Chimerism Testing Blood (PB) Ask At Order Entry"/>
<derivedFrom
value="https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder">🔗
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType">
<valueCoding>
<system value="http://hl7.org/fhir/questionnaire-derivationType"/>
<code value="extends"/>
</valueCoding>
</extension>
</derivedFrom>
<status value="draft"/>
<date value="2026-09-20T05:53:36+00:00"/>
<publisher value="NHS North West Genomics"/>
<contact>
<telecom>
<system value="url"/>
<value value="https://www.nwgenomics.nhs.uk/contact-us"/>
</telecom>
</contact>
<description
value="**Test Specific Additional Ask At Order Entry Questions** used alongside the
[common core order form](Questionnaire-GenomicTestOrder.html) for the
"Chimerism Testing Blood (PB)" order screen within Histocompatibility and
Immunogenetics orders (SNOMED CT `909871000000100`) - the same "Test
Specific" tier pattern [WGS Test Additional Ask At Order Entry
Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) follows
for WGS orders - see
[Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and
[Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions).
For the sibling HLA testing order screen, see
[HLA Tests - Transplant Ask At Order Entry](Questionnaire-HLATestsTransplantAskAtOrderEntry.html).
Extracted from the `NTE` segments of a live Histotrac `ORM^O01` order for a Chimerism
Testing (Performable) test - see the worked
[example](HistocompatibilityAndImmunogenetics.html#chimerism-testing-ask-at-order-entry)
for the full message. Unlike HLA Tests - Transplant, this order carries only two `NTE`
segments, and in the reverse order (Specimen Source before Patient Test(s)). See also
[Chimerism Testing Result Panel](Questionnaire-ChimerismResultPanel.html) for the
(separate) structured *result* payload this order eventually produces.
**Research summary**: as with [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html),
no NHS England or NHSBT-published order-comms/interoperability standard was found
specifically for Chimerism testing order entry. NHSBT's INF136 "User Guide for
Histocompatibility and Immunogenetics Diagnostics Services" defines `FRM1010` "H&I
Haematopoietic Stem Cell Transplantation (Recipients & Donors)" as the relevant national
request form for post-transplant chimerism monitoring, but does not publish a
FHIR/LOINC/SNOMED binding for the specific test-panel or specimen-source values Hive
uses. See each item below for candidate LOINC/SNOMED codes."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="GB"/>
<display value="United Kingdom of Great Britain and Northern Ireland"/>
</coding>
</jurisdiction>
<item>
<linkId value="AskAtOrderEntry"/>
<text value="Ask At Order Entry Questions"/>
<type value="group"/>
<item>
<linkId value="ChimIG/specimen_source"/>
<definition
value="http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.type.coding.code"/>
<code>
<system value="http://loinc.org"/>
<code value="66746-9"/>
<display value="Specimen Type"/>
</code>
<code>
<system value="http://snomed.info/sct"/>
<code value="123038009"/>
<display value="Specimen"/>
</code>
<text value="Specimen Source"/>
<type value="choice"/>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismBloodPB"/>
<display value="Blood (PB)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismBoneMarrowBM"/>
<display value="Bone Marrow (BM)"/>
</valueCoding>
</answerOption>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="ChimIG/specimen_source-designNote"/>
<text
value="Confirmed as this 2-value list (Blood (PB), Bone Marrow (BM)) from the
Hive/Histotrac order-entry UI's Chimerism panel - a different list from the
Blood/Buccal/Other list [HLA Tests -
Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) uses for the
same underlying `code` (LOINC `66746-9`), since the two order screens offer
different specimen-source options in Hive. Coded locally against the
`NWGMSA` CodeSystem rather than the EU/UK/NW-compatible
[Specimen Type](ValueSet-specimen-type.html) value set, to match what Hive
actually offers for this exchange. Deliberately given its own
`ChimIG/specimen_source` linkId rather than reusing the base [Genomic Test
Order](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type
item - the IG Publisher's Questionnaire derivation validator does not support a
`derivedFrom`/`extends` item reusing a base item's linkId while also declaring
more than one `answerOption`. Ordered first (before Patient Test(s)) to match
`NTE|1` in the live Histotrac order - the reverse of HLA Tests - Transplant, where
Patient Test(s) comes first."/>
<type value="display"/>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="ChimIG/specimen_source-reference"/>
<text
value="Post-transplant chimerism monitoring conventionally uses peripheral blood, with
bone marrow used for deeper/marrow-level engraftment assessment - consistent with
this 2-value list. If a coded alternative to the local `NWGMSA` codes is wanted,
the [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate
binding (e.g. whole blood specimen for Blood (PB); bone marrow specimen for Bone
Marrow (BM)). No dedicated NHS-published specimen-type binding specific to H&I
chimerism testing was found."/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="ChimIG/patient_test"/>
<definition
value="http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.orderDetail"/>
<text value="Patient Test(s)"/>
<type value="choice"/>
<repeats value="true"/>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismPeripheralBlood"/>
<display value="Chimerism Peripheral Blood"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismCD3"/>
<display value="Chimerism CD3"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismCD15"/>
<display value="Chimerism CD15"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismCD19"/>
<display value="Chimerism CD19"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="ChimerismLineageOther"/>
<display value="Chimerism Lineage Other"/>
</valueCoding>
</answerOption>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="ChimIG/patient_test-designNote"/>
<text
value="Which chimerism panel/lineage is being tested - the same Ask At Order Entry
pattern as `HistoIG/patient_test` on
[HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html)
(`repeats = true`, since the Hive UI presents them as checkboxes - more than one
may be selected per order). Confirmed as this fixed 5-value checklist from the
Hive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem, as
no NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. Ordered second
(after Specimen Source) to match `NTE|2` in the live Histotrac order, whose
NTE-3 value carries a `(PB)` suffix ("Chimerism Peripheral Blood (PB)") the Hive
checkbox label itself doesn't show - the same OBR-4-restatement behaviour as HLA
Tests - Transplant's Patient Test(s) item. Mapped to `ServiceRequest.orderDetail`
rather than `ServiceRequest.code` - the same reasoning as that item:
`ServiceRequest.code` is single-cardinality and already targeted by the base
[Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item,
with no `enableWhen` to say which wins, while `orderDetail` is repeating and
intended for exactly this kind of further order qualifier."/>
<type value="display"/>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="ChimIG/patient_test-reference"/>
<text
value="No MFT/NHS England code set was found for these five specific test names. LOINC
has short tandem repeat (STR)/chimerism-adjacent panels (e.g. `48018-6` Gene
studied, engraftment-monitoring local codes used elsewhere in genetics
laboratories) but no exact match for a CD3/CD15/CD19 lineage-specific chimerism
checklist was confirmed - a candidate future binding if a coded alternative to
the local `NWGMSA` codes is wanted. See also this IG's existing
[Chimerism](CodeSystem-Chimerism.html) CodeSystem, which covers the *result*
payload's OBX-3 sub-identifiers (STR/IM/RANGE/CV/EXT/PURE/POST/DTP/DID) rather
than these order-entry test-selection values."/>
<type value="display"/>
</item>
</item>
</item>
</Questionnaire>